Tuesday, September 18, 2007

The Hospitalist - What the heck is that?

The average American doesn't know that a revolution has occurred in medicine and there is a new type of doctor called a "Hospitalist". It is the fastest growing branch of medicine and there are 20,000 doctors today that practice only hospital medicine. Most hospitals in America employ Hospitalists and if you are admitted to a hospital, it is likely that he/she will be your main attending doctor...not your primary care physician.

The Hospitalist is a doctor with Internal Medicine or Family Practice training, who is always on site. They are available to admit patients, manage care during the day, review tests, change medication, and respond to the patient and nurses instead of rushing in at 7 AM and then back to the office to care for a full day of patients. Hospitalists don't have an office practice, nor do they follow patients once they are discharged.

Hospitals like them because they reduce length of stay and follow standard protocols of care. That should lead to improved quality but large studies to prove that need to be done.
Young doctors are flocking to this type of practice because they have regular, set hours with no "on call". They get a salary plus benefits and don't have to hassle with billing insurance, getting paid or running a practice.

But what about the patients? Many patients are shocked that their own doctor is not the attending (although many do still visit their patients in the hospital). There is concern that care will be fragmented and the Hospitalist won't have the full past history. Despite these fears, patients that experience Hospitalist's care seem satisfied and get used to the idea pretty quickly, especially if there is good communication between their primary care physician and the hospital doctor.

There is no going back. Hospitalists are here to stay and the doctor who handles both the office and the hospitalized patients will be few and far between. I personally found the mix of hospital and office practice rewarding and interesting. I enjoyed the interaction with nurses, respiratory therapists, dietitians, Xray techs and specialists when I made hospital rounds. I understand the driving forces that created Hospitalists ($$$). At the same time, I feel sorry for young Internists who will not experience the joy of practicing the full range of patient care.


Jonathan said...

I've heard the terms "patient advocate” and “ombudsman” previously used to describe hospital staff that represent patients when so requested by a patient or their family.

Other than a hospitalist being a full-time profession, how do hospitalists differ from patient advocates or an ombudsman?


K said...

Sorry, I keep thinking of "Hospitaller" whenever you say "hospitalist". I would assume there are significant differences.

Toni Brayer MD said...

Jonathan, patient advocates/ombudsman are usually customer service reps (not clinical professionals) and do no direct patient care. The Hospitalist is the attending physician and assumes direct care of the patient. The Hospitalist becomes the patient's primary doctor while the patient is in the hospital.

Toni Brayer MD said...

k, thanks for the link. I learned a new word. (Always fun!)

LovelyL said...

The nursing home business has been using attending physicians for a very long time over 30 years to my knowledge.

Nursing home patients experience some of the same issues hospital patients do with the attending physician. Only nursing homes do not have physicians on site 24/7. In fact, the attending physician is only on site 40+ hours a week not 24/7.

The concept is useful in the current mode of soaring coasts and at least an attempt at having an assigned physician to your case that might be around 40 hours per week.

Buy Cialis said...

Well it deppends supostly a friend of my told that if you study general medicine you earn almost the same money that you can earn for studying a specialty, we must remember that we work because we need the money that's it.
Good luck.

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